Sugar Land, Texas

HEALTH INSURANCE PORTABILITY AND ACCESSIBILITY ACT PRIVACY NOTICE (HIPAA)

This notice describes how medical information about you may be used and disclosed and how you can get access to this information, please review it carefully.

Uses and Disclosures of Health Information

With your consent,, we may use health information about you for treatment (such as sending your medical record information to other physicians as part of a referral), to obtain payment for treatment (such as sending billing information to health insurance plan), for administrative purposes, and to evaluate the quality of care that you receive (such as comparing patient data to improve health treatment methods).

We may use or disclose identifiable health information about you without your authorization for several reasons: Subject to certain requirements, we may give out your health information for public health purposes, abuse or neglect reporting, auditing purposes, research studies, funeral arrangements, organ donation, worker’s compensation purposes, and emergencies. We provide information when requested by law, such as for law enforcement in specific circumstances. In any other situation, we will ask for your written authorization to disclose information, you can later revoke that authorization to stop any future uses and disclosures.

We may change our policies at anytime. Before we make a significant change in our policies, we will change our notice and post the new notice in the waiting area and on our web site. You can also request a copy of our notice at anytime. For more information about our privacy practices, contact Dr. Nguyen.

Individual Rights

In most cases, you have the right to look at or get a copy of the heath information that is about you, that we use to make decisions about you. If you request copies, we will charge you 10 cents each page. You also have the right to receive a list of instances where we have disclosed health information about you for reasons other than treatment, payment, or related administrative purposes. If you believe that information in your record is incorrect or if important information is missing, you have the right to request that we correct the existing information or add the missing information.

You have the right to request that your health information be communicated to you in a confidential manner such as sending mail to an address other than your home. If this notice is sent electronically, you may obtain a paper copy of the notice.

You may request, in writing, that we not use or disclose your information for treatment, payment, or administrative purposes or to persons involved in your care except when specifically authorized by you, when required by law, or in emergent circumstances. We may consider your request but are not legally required to accept it.

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